{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T15:14:45Z","timestamp":1781190885772,"version":"3.54.1"},"reference-count":46,"publisher":"The Pediatric Pharmacy Association","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,6]]},"abstract":"\n OBJECTIVE<\/jats:title>\n To determine if implementation of a tiered clonidine dosing protocol reduces the incidence of withdrawal compared with the preintervention phase.<\/jats:p>\n <\/jats:sec>\n \n METHODS<\/jats:title>\n This is a pre- and postinterventional cohort study in which preintervention data were collected for 6 months for baseline incidence of dexmedetomidine withdrawal and institutional practice of clonidine use. This was followed by implementation of an enteral clonidine dosing protocol based on the length of dexmedetomidine infusion and continued data collection for an additional 6 months. Patients were enrolled in both arms after \u226572 hours on dexmedetomidine. Withdrawal was described as tachycardia or hypertension and elevated Withdrawal Assessment Tool-1 or study questionnaire scores.<\/jats:p>\n <\/jats:sec>\n \n RESULTS<\/jats:title>\n The preintervention phase had 49 patients included in analysis and the intervention phase had 30 patients. Incidence of withdrawal in the overall preintervention vs intervention cohorts was not significantly different, but in patients who received clonidine there was a trend towards less withdrawal in the intervention vs preintervention cohort (36% vs 52%). The hours on dexmedetomidine nor cumulative dexmedetomidine dose differed between the cohorts (161.5 vs 152.8 hours, p = 0.49; 126.34 vs 134.76 mcg\/kg, p = 0.54). With implementation of the protocol, more patients were weaned off dexmedetomidine within 24 hours (67% vs 39%, p = 0.06).<\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS<\/jats:title>\n To the authors\u2019 knowledge, this is the first prospective study assessing the use of an enteral clonidine dosing protocol to prevent dexmedetomidine withdrawal in children. With implementation of the protocol a trend towards reduction in withdrawal in the intervention cohort was documented despite faster weaning time with similar dexmedetomidine exposure.<\/jats:p>\n <\/jats:sec>","DOI":"10.5863\/jppt-25-00044","type":"journal-article","created":{"date-parts":[[2026,4,16]],"date-time":"2026-04-16T00:36:12Z","timestamp":1776299772000},"page":"399-406","source":"Crossref","is-referenced-by-count":0,"title":["Tiered Approach to Clonidine Dosing to Prevent Dexmedetomidine Withdrawal in Children: A Prospective Pre and Post Interventional Cohort Study"],"prefix":"10.5863","volume":"31","author":[{"given":"Andrea L.","family":"Heifner","sequence":"first","affiliation":[{"name":"Department of Pediatrics, Pediatric Critical Care (ALH, JNN, TLN), University of Texas Health Science Center at Houston, Houston, TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Weng M.","family":"Lam","sequence":"additional","affiliation":[{"name":"Department of Pharmacy (WML), Children\u2019s Memorial Hermann Hospital, Houston, TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monica","family":"Lee","sequence":"additional","affiliation":[{"name":"Syneos Health (ML); Department of Pediatrics, Children\u2019s Heart Institute\/Pediatric Cardiac Critical Care (DEM), University of Texas Health Science Center at Houston, Houston, TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer N.","family":"Nguyen","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Pediatric Critical Care (ALH, JNN, TLN), University of Texas Health Science Center at Houston, Houston, TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David E.","family":"McMann","sequence":"additional","affiliation":[{"name":"Syneos Health (ML); Department of Pediatrics, Children\u2019s Heart Institute\/Pediatric Cardiac Critical Care (DEM), University of Texas Health Science Center at Houston, Houston, TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thao L.","family":"Nguyen","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Pediatric Critical Care (ALH, JNN, TLN), University of Texas Health Science Center at Houston, Houston, TX"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"3883","reference":[{"issue":"2","key":"JPPT-25-00044-b01","series-title":"Pediatr Crit Care Med","first-page":"115","article-title":"Dexmedetomidine: applications in pediatric critical care and pediatric anesthesiology","volume":"8","author":"Tobias","year":"2007","unstructured":"Tobias JD. Dexmedetomidine: applications in pediatric critical care and pediatric anesthesiology. Pediatr Crit Care Med. 2007;8(2):115\u2013131."},{"key":"JPPT-25-00044-b02","article-title":"Precedex (dexmedetomidine) [package insert]","unstructured":"Precedex (dexmedetomidine) [package insert]. Hospira Pharmaceutical company. US Food and Drug Administration. Accessed March 12, 2024. https:\/\/www.accessdata.fda.gov\/drugsatfda_docs\/label\/2022\/021038s028lbl.pdf"},{"key":"JPPT-25-00044-b03","series-title":"Pediatr Crit Care Med","first-page":"e74","article-title":"2022 Society of Critical Care Medicine clinical practice guidelines on prevention and management of pain, agitation, neuromuscular blockade, and delirium in critically ill pediatric patients with consideration of the ICU environment and early mobility","volume":"23","author":"Smith","year":"2022","unstructured":"Smith HAB, Besunder JB, Betters KA, et al. 2022 Society of Critical Care Medicine clinical practice guidelines on prevention and management of pain, agitation, neuromuscular blockade, and delirium in critically ill pediatric patients with consideration of the ICU environment and early mobility. Pediatr Crit Care Med. 2022;23:e74\u2013e110."},{"key":"JPPT-25-00044-b04","series-title":"Pediatr Crit Care Med","first-page":"625","article-title":"Pediatric Neurological Protection and Drugs (PeNPAD) Study Group of the Italian Society of Neonatal and Pediatric Anesthesia and Intensive Care (SARNePI). Efficacy and safety of dexmedetomidine for prolonged sedation in the PICU: a prospective multicenter study (PROSDEX).","volume":"21","author":"Sperotto","year":"2020","unstructured":"Sperotto F, Mondardini MC, Dell\u2019Oste C, et al; Pediatric Neurological Protection and Drugs (PeNPAD) Study Group of the Italian Society of Neonatal and Pediatric Anesthesia and Intensive Care (SARNePI). Efficacy and safety of dexmedetomidine for prolonged sedation in the PICU: a prospective multicenter study (PROSDEX). Pediatr Crit Care Med. 2020;21:625\u2013636."},{"issue":"1","key":"JPPT-25-00044-b05","series-title":"J Pediatr Pharmacol Ther","first-page":"16","article-title":"Survey of the current use of dexmedetomidine and management of withdrawal symptoms in critically ill children","volume":"24","author":"Thompson","year":"2019","unstructured":"Thompson RZ, Gardner BM, Autry EB, et al. Survey of the current use of dexmedetomidine and management of withdrawal symptoms in critically ill children. J Pediatr Pharmacol Ther. 2019;24(1):16\u201321."},{"issue":"1","key":"JPPT-25-00044-b06","series-title":"Pediatr Crit Care Med","first-page":"62","article-title":"Dexmedetomidine withdrawal syndrome in children in the PICU: systematic review and meta-analysis","volume":"25","author":"Knapp","year":"2024","unstructured":"Knapp T, DiLeonardo O, Maul T, et al. Dexmedetomidine withdrawal syndrome in children in the PICU: systematic review and meta-analysis. Pediatr Crit Care Med. 2024;25(1):62\u201371."},{"key":"JPPT-25-00044-b07","series-title":"Pediatr Crit Care Med","first-page":"706","article-title":"Long-term dexmedetomidine use and safety profile among critically ill children and neonates","volume":"15","author":"Whalen","year":"2014","unstructured":"Whalen LD, Di Gennaro JL, Irby GA, et al. Long-term dexmedetomidine use and safety profile among critically ill children and neonates. Pediatr Crit Care Med. 2014;15:706\u2013714."},{"issue":"2","key":"JPPT-25-00044-b08","series-title":"J Pediatr Pharmacol Ther","first-page":"104","article-title":"Evaluating the transition from dexmedetomidine to clonidine for the prevention of withdrawal in critically ill pediatric patients","volume":"25","author":"Lee","year":"2020","unstructured":"Lee MM, Caylor K, Gockenbach N. Evaluating the transition from dexmedetomidine to clonidine for the prevention of withdrawal in critically ill pediatric patients. 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J Pediatr Pharmacol Ther. 2015;20(1):45\u201353."},{"issue":"1","key":"JPPT-25-00044-b15","series-title":"J Pediatr Pharmacol Ther","first-page":"81","article-title":"Prevention of withdrawal in pediatric patients receiving long-term dexmedetomidine infusions","volume":"26","author":"Berrens","year":"2021","unstructured":"Berrens ZJ, Sauro AL, Tillman EM. Prevention of withdrawal in pediatric patients receiving long-term dexmedetomidine infusions. J Pediatr Pharmacol Ther. 2021;26(1):81\u201386."},{"issue":"2","key":"JPPT-25-00044-b16","series-title":"Anaesthesia","first-page":"146","article-title":"Alpha-2 and imidazoline receptor agonists. Their pharmacology and therapeutic role","volume":"54","author":"Khan","year":"1999","unstructured":"Khan ZP, Ferguson CN, Jones RM. Alpha-2 and imidazoline receptor agonists. Their pharmacology and therapeutic role. 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Dexmedetomidine use in a pediatric intensive care unit: a retrospective cohort study. Ann Pharmacother. 2018;52:133\u2013139."},{"issue":"1","key":"JPPT-25-00044-b23","series-title":"Pediatr Crit Care Med","first-page":"e67","article-title":"Development and preliminary testing of the Withdrawal Assessment Tool-Alpha 2 Agonist: an assessment instrument for monitoring iatrogenic withdrawal symptoms in children receiving an alpha-2 agonist","volume":"26","author":"Solodiuk","year":"2025","unstructured":"Solodiuk JC, Donado C, Wickerham L, et al. Development and preliminary testing of the Withdrawal Assessment Tool-Alpha 2 Agonist: an assessment instrument for monitoring iatrogenic withdrawal symptoms in children receiving an alpha-2 agonist. 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J Pediatr Pharmacol Ther. 2020;25(2);104\u2013110."},{"issue":"1","key":"JPPT-25-00044-b09","series-title":"Can J Hosp Pharm","first-page":"21","article-title":"Safety and effectiveness of dexmedetomidine in the pediatric intensive care unit (SAD-PICU)","volume":"66","author":"Carney","year":"2013","unstructured":"Carney L, Kendrick J, Carr R. Safety and effectiveness of dexmedetomidine in the pediatric intensive care unit (SAD-PICU). Can J Hosp Pharm. 2013;66(1):21\u201327."},{"issue":"4","key":"JPPT-25-00044-b10","series-title":"J Pediatr Intensive Care","first-page":"327","article-title":"Evaluation of an enteral clonidine taper following prolonged dexmedetomidine exposure in critically ill children","volume":"11","author":"Crabtree","year":"2021","unstructured":"Crabtree MF, Sargel CL, Cloyd CP, et al. Evaluation of an enteral clonidine taper following prolonged dexmedetomidine exposure in critically ill children. J Pediatr Intensive Care. 2021;11(4):327\u2013334."},{"issue":"6","key":"JPPT-25-00044-b11","series-title":"J Pediatr Pharmacol Ther","first-page":"453","article-title":"Prolonged dexmedetomidine infusion and drug withdrawal in critically ill children","volume":"22","author":"Haenecour","year":"2017","unstructured":"Haenecour AS, Seto W, Urbain CM, et al. Prolonged dexmedetomidine infusion and drug withdrawal in critically ill children. J Pediatr Pharmacol Ther. 2017;22(6):453\u2013460."},{"issue":"4","key":"JPPT-25-00044-b12","series-title":"Pediatr Crit Care Med","first-page":"287","article-title":"Dexmedetomidine as single continuous sedative during noninvasive ventilation: typical usage, hemodynamic effects, and withdrawal","volume":"19","author":"Shutes","year":"2018","unstructured":"Shutes BL, Gee SW, Sargel CL, et al. Dexmedetomidine as single continuous sedative during noninvasive ventilation: typical usage, hemodynamic effects, and withdrawal. Pediatr Crit Care Med. 2018;19(4):287\u2013297."},{"issue":"8","key":"JPPT-25-00044-b13","series-title":"J Pediatr Pharmacol Ther","first-page":"821","article-title":"Clonidine for the treatment of agitation after dexmedetomidine discontinuation in pediatric patients: a retrospective cohort study","volume":"26","author":"Nguyen","year":"2021","unstructured":"Nguyen TL, Lam WM, Orr H, et al. Clonidine for the treatment of agitation after dexmedetomidine discontinuation in pediatric patients: a retrospective cohort study. J Pediatr Pharmacol Ther. 2021;26(8):821\u2013827."},{"issue":"1","key":"JPPT-25-00044-b14","series-title":"J Pediatr Pharmacol Ther","first-page":"45","article-title":"Effects of clonidine on withdrawal from long-term dexmedetomidine in the pediatric patient","volume":"20","author":"Lardieri","year":"2015","unstructured":"Lardieri AB, Fusco NM, Simone S, et al. Effects of clonidine on withdrawal from long-term dexmedetomidine in the pediatric patient. J Pediatr Pharmacol Ther. 2015;20(1):45\u201353."},{"issue":"1","key":"JPPT-25-00044-b15","series-title":"J Pediatr Pharmacol Ther","first-page":"81","article-title":"Prevention of withdrawal in pediatric patients receiving long-term dexmedetomidine infusions","volume":"26","author":"Berrens","year":"2021","unstructured":"Berrens ZJ, Sauro AL, Tillman EM. Prevention of withdrawal in pediatric patients receiving long-term dexmedetomidine infusions. J Pediatr Pharmacol Ther. 2021;26(1):81\u201386."},{"issue":"2","key":"JPPT-25-00044-b16","series-title":"Anaesthesia","first-page":"146","article-title":"Alpha-2 and imidazoline receptor agonists. Their pharmacology and therapeutic role","volume":"54","author":"Khan","year":"1999","unstructured":"Khan ZP, Ferguson CN, Jones RM. Alpha-2 and imidazoline receptor agonists. Their pharmacology and therapeutic role. 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The impact of a clonidine transition protocol on dexmedetomidine withdrawal in critically ill pediatric patients. J Pediatr Pharmacol Ther. 2020;25(4):278\u2013287."},{"issue":"6","key":"JPPT-25-00044-b19","series-title":"Intensive Care Med","first-page":"1075","article-title":"Construction of the Sophia Observation withdrawal Symptoms-scale (SOS) for critically ill children","volume":"35","author":"Ista","year":"2009","unstructured":"Ista E, van Dijk M, de Hoog M, et al. Construction of the Sophia Observation withdrawal Symptoms-scale (SOS) for critically ill children. Intensive Care Med. 2009;35(6):1075\u20131081."},{"issue":"8","key":"JPPT-25-00044-b20","series-title":"Pediatr Crit Care Med","first-page":"761","article-title":"Psychometric evaluation of the Sophia Observation withdrawal symptoms scale in critically ill children","volume":"14","author":"Ista","year":"2013","unstructured":"Ista E, de Hoog M, Tibboel D, et al. 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